International Journal of Fertility & Sterility
Year:2012 | Volume:6 | Issue:2|Papers Count:11

Background: This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure (RIF).Materials and Methods: In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF.Results: Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients’ mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG) day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group.Conclusion: In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation (COH). Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients.

Background: The preconception period is crucial to fertility and pregnancy health. Offering education and counseling to couples being treated for infertility improves the outlook of treatment. The aim of this study is to assess preconception education and counseling in a population of Iranian couples treated for infertility.Materials and Methods: This is a cross-sectional study of 268 individuals who presented to fertility clinics across the city of Isfahan, Iran. Questionnaires and patient records were used to collect data. We evaluated the components of standard preconception counseling (lifestyle, diet, sexual health, substance abuse, and social counseling) versus preconception counseling offered to couples that were receiving infertility treatment (failure, follow-up, and side effects of treatment).Results: We found that no counseling had been given to about 76.9% about lifestyle, 70.9% about diet, 90.7% about sexual health, and 90.7% about the psychosocial aspects of infertility. No counseling had been given to 46.6% of individuals about a follow-up and also to 46.6% of individuals about the side effects of treatment. In more than 75% of the cases, counseling was offered to couples whose etiology of infertility was unknown.Conclusion: We have found serious flaws in the education and preconception counseling of infertile Iranian couples; action is required by medical and health teams to address these shortcomings.

Background: Considering the high prevalence of psychiatric disorders among infertile women, it seems that gynecologists, psychiatrists, and psychologists should be more attentive to identify and treat these disorders. The aim of this study is to determine the effect of E-cognitive group therapy with emotional disclosure on mentwal health status of infertile women who are receiving assisted reproduction.Materials and Methods: In this randomized clinical trial study, 80 infertile women who were receiving hormonal therapy or other assisted reproductive technologies (ART) were randomly allocated to the cognitive-behavioral treatment (CBT) group or the control group. The CBT group had a weekly 12-hour meeting for a period of three months. They also participated in some painting sessions (art therapy) and written and verbal emotional disclosure (both individually and in group presentation). The Depression, Anxiety, Stress Scales (DASS) test and Penn State Worry Questionnaire (PSWQ) were used for data gathering.Results: Results showed the level of psychological distress decreased in the control group, but not significantly. Psychological intervention in the treatment group significantly lowered the level of psychological distress; the mean score of DASS in all aspects was significant. The difference between the mean score of the two groups after intervention was significant (p=0.001) and also according to ANCOVA (p=0.002). Differences were significant between the mean scores of both groups in the PSWQ (p=0.001), Inventory Test (p=0.001), which was confirmed by ANCOVA (p=0.009).Conclusion: These finding suggest that CBT with emotional self-disclosure promotes coping strategies among infertile women. Results also show that these approaches develop mental health and decrease stress in infertile women. Using a psychiatric approach in medical settings could help infertile women to promote their adjustment with mental health problems due to of in infertility. (Registration Number: IRCT201108247407N2).

Background: Varicocele, the abnormal dilatation of the veins in the pampiniform plexus is commonly seen in infertile patients. In this study, we aim to examine sperm DNA damage after the creation of experimental varicocele in rats and to observe the change of this damage after a varicocelectomy.Materials and Methods: In this experimental study, a total of 30 adult male Wistar albino rats were divided into three groups. The 10 rats in group 1 underwent a sham operation, an experimental varicocele was created in both the10 rats in group 2 and the 10 rats in group 3 (a total of 20 rats). While the rats of group 2 were sacrificed after four weeks, the rats in group 3 underwent a varicocelectomy after four weeks and were sacrificed four weeks after the varicocelectomy to observe its effects. Sperm DNA fragmentation was assessed with a Halomax® kit. The DNA Fragmentation Index (DFI) was calculated and the groups were compared according to their DFI. Statistical analysis was performed using the Mann-Whitney U test.Results: Median sperm DFI was 17.6 (range: 7.6) in the right testicle and 18.3 (range: 6.8) in the left testicle in the control group; 30.7 (range: 8.8) in the right testicle and 31.8 (range: 9.6) in the left testicle in the varicocele group; 27.1 (range: 8.1) in the right testicle and 28.6 (range: 8.9) in the left testicle in the varicocelectomy group. DNA damage in both right and left testicles was statistically significant between the three groups (p<0.05).Conclusion: The results of this study show that varicocele leads to increased sperm DNA damage and this damage is decreased by varicocelectomy.

Background: Chlamydia trachomatis (C. trachomatis) is the most prevalent cause of bacterial sexually transmitted infections (STI) recognized throughout the world. The aim of this study is to determine different genotypes of genital C. trachomatis and the association between the serological markers of inflammation and genotypes of C. trachomatis in sexually active women (n=80) attending Shahid Beheshti Hospital in Isfahan, Iran.Materials and Methods: In this descriptive study, endocervical swabs were collected from 80 women. There were 17 endocervical samples that showed positivity for C. trachomatisby plasmid polymerase chain reaction (PCR) using KL1 and KL2 primers. The omp1 gene was directly amplified in 17 plasmid PCR positive samples and was usedto differentiate the clinical genotypes by omp1 gene PCR-restriction fragment length polymorphism (PCR-RFLP). The levels of IgG and IgA specific to C. trachmatis and C-reactive protein (CRP) were evaluated.Results: Based on restriction-digestion patterns, four genotypes were identified. Genotypes E (35.3%) and F (35.3%) were the most prevalent, followed by D/Da (23.5%) and K (5.9%). There was no significant association between genotypes and the presence of IgG and CRP. Patients infected with genotype E showed a serological marker of chronic inflammation, i.e. IgA seropositivity, significantly more than patients infected with other genotypes (p=0.042).Conclusion: Nested PCR could increase the sensitivity of omp1 amplification. Based on the presence of IgA, chronic C. trachomatis infections were observed more frequently among genotype E-infected patients in our population.

Background: Pregnancy stimulates partners to search for ways to preserve their mutual emotional relations and satisfy their sexual needs, with some limitations. This study evaluates the frequency and perception of sexual intercourse during pregnancy in a group of Iranian couples.Materials and Methods: In this cross-sectional study, 155 pregnant women were recruited from two academic clinics in Tehran. The exclusion criteria were: any underlying disease, history of pelvic surgery or gynecologic and obstetric complications, abortion or sterility, and previous preterm labor. A checklist was administrated in the labor room, that included: demographic data, partus and their viewpoints about sexuality. Frequency of sexual activity in each trimester, vaginal intercourse, coitus position, orgasm, breast stimulation, condom usage, and pregnancy outcome were recorded. Data were analyzed with t- and chi-square tests.Results: Women and their husbands with sexual behaviors during pregnancy had a lower mean age; the majority were nulipara (p<0.05). The biggest reason for decreased intercourse in the first trimester was fear of abortion (39.45%). No significant relationship between sexual activity in pregnancy and preterm labor, gestational age, membrane rupture, and fetal outcome was shown. There was a significant negative relationship between intercourse in the 2nd and 3rd trimesters and need to induction.Conclusion: Although our results showed that sexual intercourse had no adverse effect on the fetus and was a proper stimulus for the induction of delivery, its frequency was reduced during the gestational stage due to parents’ fear of adverse effects.

Background: Nitric oxide (NO) involves in polycystic ovary syndrome (PCOS), a cause of infertility in women during the reproductive age. The PCOS is now categorized as an inflammatory phenomenon. The aim of this study was to evaluate the role of NO, a proinflammatory agent, in this syndrome at histological and biochemical levels.Materials and Methods: In this experimental study, animals were female Wistar rats (weighing 200-250 g) kept under standard conditions. L-Arginine (50-200 mg/kg), a precursor of NO, was injected intra-peritoneally (i.p.) through a period ranging from 9 to14 days/ once a day. The rats' estrous cycle was studied using Papanicolaou test; those showing phase of Diestrous were grouped into experimental and control groups. The control group solely received saline (1 ml/kg, i.p.) throughout all experiments. To evaluate the inflammatory effect of NO, the rats were treated an anti-inflammatory agent, naloxone hydrochloride (0.4 mg/kg, i.p.), prior to L-arginine. At the end of the treatment period all animals’ ovaries were assessed for histopathological and histochemical investigations. Also, activation of NO synthase (NOS) in the experiments was studied using NADPH-diaphorase technique.Results: The ovaries of rats treated with L-arginine showed polycystic characteristics in contrast to those collected from control or naloxone pretreated groups, based on image analysis. A difference in enzyme activation was also shown in the sections that belonged to the groups that received L-arginine when compared with the pre-naloxone and control groups.Conclusion: Based on these results, we believe that NO may play a major role in the pathophysiology of PCOS.

Background: Polycystic ovary syndrome (PCOS) patients are more prone to abnormal production of some regulatory peptides. In these patients, studies on the serum levels of leptin and ghrelin are controversial. This study aims to investigate serum levels of leptin and ghrelin and their correlation with metabolic and endocrine indices in PCOS.Materials and Methods: This case-control study was conducted on 60 women; 30 with PCOS and 30 healthy women whose age and body mass index (BMI) were matched and who were referred to Alzahra Hospital, Tabriz, Iran. Serum levels of leptin, ghrelin, insulin, luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and testosterone were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Descriptive statistics and correlations were performed using SPSS 12.0 for Windows.Results: In PCOS women, serum levels of leptin, insulin, HOMA-IR, testosterone, LH, and LH/FSH were significantly higher, while SHBG was lower than in healthy women. Ghrelin and FSH were similar in both groups. Serum levels of leptin correlated with BMI (r=0.85, p<0.001), waist to hip ratio (WHR) (r=0.55, p<0.01), insulin levels (r=0.85, p<0.001) and HOMA-IR (r=0.67, p<0.01), while ghrelin levels had an inverse association with testosterone (r=-0.32, p=0.04).Conclusion: The results showed increased leptin levels while ghrelin remained unchanged in PCOS patients. In PCOS patients, leptin positively correlated with BMI, WHR, insulin, and insulin resistance, while ghrelin was only associated with serum testosterone levels.

Background: This study was undertaken to determine if there were different abortion rates between normal and abnormal yolk sacs.Materials and Methods: In this cohort study, the yolk sac characteristics of 193 consecutive pregnant women, of 5-6.5 weeks gestation, with normal body mass index (BMI) were prospectively evaluated. All patients underwent two-dimensional transvaginal ultrasonography, which was performed by the same sonographer. We considered the following yolk sac characteristics as normal for classification: diameter: 2-5 mm; round shape; absence of degenerative changes; equal number with embryos; echogenic rim and hypoechoic center. Yolk sacs that had diameters smaller than 2 mm or larger than 5 mm; a shape that was not round (i.e., oval or distorted); the presence of degenerative changes; hyper- or hypo-echogenic rim; hyperechoic center and unequal number with embryos were considered abnormal. Based on the above classification, patients were divided into two groups, study (abnormal yolk sac) and control (normal yolk sac). The study group contained 22 cases and the control group consisted of 164 cases. The primary outcome measure was the abortion rate between both groups. Chi-square and students’t test were used for data analysis.Results: A total of 193 cases were evaluated. We excluded 2 cases. Among the remaining 191 cases, 22 (11.51%) had abnormal yolk sacs of which spontaneous abortion occurred in 14 (63.63%) cases. In the control group, out of 169 (89.49%) cases, spontaneous abortion was noted in 6 (3.55%). There was a statistically significant difference in abortion rates between the two groups (p=0.000).Conclusion: According to the results of this study, it is obvious that abnormal yolk sac characteristics are associated with spontaneous abortion.

Ectopic pregnancy is defined as the implantation and development of an embryo outside the uterus. Its incidence has increased over the past two decades. We report two cases of interstitial pregnancy on a tubal stump following bilateral salpingectomy and in vitro fertilization (IVF) treatments. We emphasize the importance of total salpingectomy during surgery in order to avoid interstitial pregnancy, particularly in women undergoing IVF treatments.

We present a conjoined twin (CT) case of pregnancy in a 31-year-old woman (gravida 2, para1) who came for her first routine ultrasound at 18 weeks of gestation. She conceived by spontaneous conception. The patient had a healthy child from a previous pregnancy. The initial ultrasound revealed two fetuses with a fused thorax and abdomen, two spines with an unusual extension, one beating heart, shared liver across the fetuses, four kidneys, two bladders, four normally formed arms and legs, and the pelvic were separate with two female external genitalia (Fig 1). The cord had multiple vessels and the abdomen of both fetuses was notable for moderate ascites. With a definite diagnosis of thoracoomphalopagus type of CT that is incompatible with life, the parents decided to terminate the pregnancy.